What are the recommended lifestyle modifications for patients with hyperlipidaemia before initiating pharmacotherapy?

Recommended lifestyle modifications for patients with hyperlipidaemia before initiating pharmacological management include:

• Adopt a diet where total fat intake is 30% or less of total energy intake, with saturated fats making up less than 7-10% of total energy intake, and dietary cholesterol less than 300 mg/day. Replace saturated fats with monounsaturated and polyunsaturated fats such as olive oil or rapeseed oil.
• Consume at least 5 portions of fruit and vegetables daily, in line with national guidance.
• Eat at least 2 portions of fish per week, including one portion of oily fish; pregnant women should limit oily fish to 2 portions per week.
• Engage in physical activity consistent with national guidelines for the general population, including aerobic and muscle-strengthening activities; if moderate-intensity activity is not possible due to comorbidities, exercise at the maximum safe capacity is encouraged. Recommended activities include brisk walking, using stairs, and cycling.
• Manage weight appropriately, offering advice and support to achieve and maintain a healthy weight if overweight or obese.
• Limit alcohol consumption to recommended levels (up to 3-4 units/day for men and 2-3 units/day for women) and avoid binge drinking.
• Advise smoking cessation and provide support to stop smoking.

These lifestyle interventions should be regarded as components of medical management and not substitutes for pharmacological treatment when indicated. Patients should be supported to make these changes, with referral to exercise schemes or smoking cessation services as needed. After a period of lifestyle modification, reassessment of cardiovascular risk should be performed to guide the need for lipid-lowering therapy.

References: ¹,²,⁶